Routinely used various reasons

• Provide compression to minimize swelling 

Should never be used as a substitute for rehab 

Elastic Wrap application 

• Pressure and tension should be standardized 

• Should be wrapped in position for maximum contraction 

• More turns with moderate tension would cause more loss of circulation compared to less turns with maximum tension 

60-70% of force should be used on tension of wrap 

Need to overlap the tape by half to reduce blistering and pressure points 

Needs to be smooth when taping 

Make sure the pressure itself is consistent 

Mechanical forces of injury 

~Types of forces 

1. Tensile (Pulling, force is parallel to the fibers) 

2. Shear (Stretching,force is perpendicular to the fibers)

3. Compression (Smashing, crushing of the fibers)

4. 3-point bending (combination of all 3 forces)

• Each type of tissues has a limit for how much force it can withstand (critical force)

• Age, temperature, skeletal maturity, gender, and body weight can affect the mechanical properties 

~ Load (critical force) Deformation Curve 

• The curve describing how much force our muscles, ligaments, tendons, etc can take before failure (injury)

~Healing process following an injury 

• Starts with Inflammatory response, response to encase the injury or damage 

~usually one to four days 

• Then the Fibroblastic repair occurs, when the discoloration occurs, the damaged cells are dying and are being repaired, once the swelling has left the next stage begins

• Finally there is the Maturation Remodeling stage which is the rebuilding of the affected area to get back to 100% 

~The inflammatory process 

• Normal signs and symptoms 

1. Swelling or edema 

2. Pain 

3. Reddening of the skin 

4. Increased temperature in the affected area 

5. Loss of function 

• Initial trauma causes destruction of cells and damages blood vessels 

• In response to injury, chemicals are released that affect vascular system and nearby cells 

• The effects of these chemicals are:

- Degradative (cellular breakdown)

- Vasoactive (vasodilators)

- Chemotactic (attract scavenger cells)

• Vasoactive and Chemotactic response 

- Release of histamines, bradykinins, and prostaglandins into the bloodstream 

• Pain/ Vasodilation/ Permeability 

~Inflammatory phase 

• Due to vasodilation and vessel permeability allow for plasma proteins, platelets, macrophages, neutrophils, and leukocytes move out of the capillaries to injured tissue 

• Neutrophils and leukocytes engage in phagocytosis  which eat dead or dying cells 

~Inflammation also occurs from secondary metabolic injury: or Hypoxia 

• No oxygen available and cellular death from the lack of oxygen 

• This is called SECONDARY INJURY

Platelet: what clots the blood to stop bleeding 

Neutrophils: WBC that helps fight infection by ingesting microorganisms 

Pain and Injury 

• Tells the body where there is tissue damage currently 

Fibroblastic Repair phase 

• Polymorphs, monocytes, and histiocytes migrate into the area of injury 

• These cells break down cellular debris and set the stage for regeneration and repair 

• You have the formation of new capillaries 

• Connective tissues heal by forming scar tissue 

• Fibroblasts migrate into the damaged area and mature 

Maturation Phase

Acute traumatic injuries 

1. Fractures 

2. dislocations/subluxations 

3. Strains 

4. Contusions 

5. Strains 

6. Nerve injuries

Fractures 

• Diaphysis - Shaft-hollow and cylindrical 

• Epiphysis - Found at the ends of bones and hyaline cartilage growth 

• Growth plate- a thin layer of cartilage 

Stress fracture 

• Occur from repetitive force 

• Overload due to muscle contraction altered stress distribution due to muscle fatigue changes in surface 

• They get worse overtime due to repetitive motions 

Management 

• Hard to catch with x ray 

• If suspected stop activity for 14 days 

• Usually doesn't require casting 

COntusions

• Superficial will produce bruising but a bone contusion will not have this because it is too deep for the blood to pool 

Muscle strains and injuries 

• Strain is on a 1, 2 ,3 scale 

• Strain is for muscles sprain is fro ligaments 

Chronic overuse injuries (tendonitis)

• Often get stuck in the inflammatory phase 

~Myofascial trigger point 

• Occurs at the motor unit, where the nerves intervate on the muscle to send signals to the muscle 

Intervention procedure 

~No clear set of criteria for treatment of acute soft-tissue injury.

Several options 

• Cryotherapy includes bags of crushed ice, ice cups, ice water immersion, and commercial cold packs

~used to stop swelling 

• After the acute phase, thermotherapy is appropriate (ex: hydrocollator packs, moist warm towels, and ultrasound diathermy)

When an injury occurs, cryotherapy is needed after the injury. If it is not right after then the body will still have the swelling which we are trying to avoid. 

~Icomosis: discoloration starts at the injury site

• Shows us that the swelling phase has stopped 

When we ice we slow down the process in the injury area but after the swelling phase we move into the heat phase which speeds up the recovery in injury 

RICE

~Best for soft tissue injuries and paired with rehabilitative exercise 

R- REST (should be for 48 hours)

I - ICE (20 min at a time, 4-8 times a day)

C - Compression (Reduce swelling)

E - Elevate (6-10 in above the heart)

Police 

~

P - Protect

O - Optimal Loading (Doing as much as you can without excessive pain) 

L 

I - Ice

C -  Compression

E- Elevate

Peace and Love 

~

P - protection 

E - Elevate 

A - Avoid anti-inflammatories (bad because we still want swelling in the area)

C - Compression 

E - Education (Know your body, let things take their time)

&

L - Load (Let pain guide you to gradually return)

O - Optimism 

V - Vascularisation (choose pain-free cardiovascular activities to increase blood flow)

E - Exercise 

Anatomy of the Ankle and Foot 

Ligaments 

• Deltoid ligament is the primary stabilizer of the MEDIAL SIDE of the ankle joint 

• Lateral side : 3 lateral ligaments and 2 Anterior/posterior side 

~Lateral 

1. Anterior talofibular 

2. Posterior talofibular 

3. Calcaneofibular 

~Anterior/posterior 

1. Anterior tibiofibular 

2. Posterior Tibiofibular 

Four arches of the foot 

1. Medial longitudinal arch 

2. LAteral longitudinal arch 

3. Metatarsal arch 

4. Transverse arch 

Plantar Fascia 

Ligaments that connect the heel all the way to the metatarsals 

Functions 

1. Shape of the arch 

2. Shock absorption 

3. Stabilizes the arch 

Muscle of the lower leg 

3 sections of the lateral calf 

1. Peroneus long 

2. Peroneus brevis 

3. Peroneus tertius 

Common injuries of the foot and toes 

• Fractures

• Bursitis 

• Tendonitis 

• Etc 

Bursitis 

~Achielies bursitis 

• Fluid filled sac to reduce swelling 

• When the bursa sac is struck it will swell 

Plantar fasciitis 

• When the tissue is inflamed or too tight it will be tender and affect walking 

• Bottom of the foot and it usually closer to the heel

Heel bruises and heel spurs 

- Heel bruise 

• Irritation of fat pad 

• Cannot withstand weight 

• Can become chronic inflammation of the bone covering 

~Heel spurs 

• Can be related to chronic heel bruise and plantar fasciitis 

• Chronic inflammation can result in ossification on bottom of the heel 

Treatment 

• Applying a donut shaped gel pad to reduce weight bearing 

Morton's foot 

• When the 1st metatarsal is shortened 

Or 

• An elongated 2nd metatarsal 

• Results in weight shift to the 2nd metatarsal which can cause pain and shipping of the front of the 2nd metatarsal

Can result in 

1. Metatarsalgia

• Flattening of the metatarsal arch 

2. Mortons Neuroma 

• An abnormal growth of fluid that fills in between the metatarsals which puts pressure on a nerve 

Arch Problems 

Pes planus 

• Flat foot, over pronation 

• Causes stress on the plantar fascia 

• Corrective arch orthosis or shoe selection is most beneficial 

Pes Cavus

• High arch amd associated with plantar fasciitis 

• Athlete may benefit from orthotic device 

Turf toe 

~Cause of injury

• Hyperextension injury resulting in spain of 1st metatarsophalangeal joint 

• Tendonitis of Flexor hallicus Longus Tendon 

• Happens on the plantar side of the foot 

Bunions 

 ~ May result from inflamed bursa or joint deformities 

• Typical at 1st metatarsophalangeal joint, but 5th metatarsophalangeal can also be affected 

• Often caused by improper shoes 

Toe Bruise 

• Common injuries are torn-off hails or Subungual hematoma formation under the nail (blood blister under the nail bed 

• Hematomas under nail needs to be released 

• Use commercially available nail bore to drill small hole in the nail to release blood

Ingrown Nail 

~ Ingrown toenails may result from improperly fitting shoes 

• Soak infected toe in warm antibacterial solution 

• Elevate toenail by placing a small cotton roll under it and leave in place as nail grows 

• Have athlete wear shoes that fit more comfortably 

INFECTION IS THE BIGGEST CONCERN 

Blisters and Calluses 

~ common formations resulting from friction between layers of skin as a result of improper fit or broken in shoes 

Blister

• When a blister forms, fluid collects between skin layers, occasionally the fluid will contain blood 

• Large blisters should be drained and the area padded to prevent further friction 

Calluses

• Form around bony areas 

• File/buff to prevent growth 

• Done because with calluses it can change your gait since the callus will raise your foot 

Hard and Soft Corns 

~Cause of condition 

• Results in pressure from improperly fitting shoes 

• Wearing narrow shoes and excessive foot perspiration 

• Poor foot hygiene 

• Heavily infected areas, can cause death of the tissue 

Ankle and Lower leg 

Bones of ankle and foot 

• Tarsals 

- talus 

- calcaneus 

• Tibia 

• Fibula 

Ligaments 

• The deltoid ligaments is the primary stabilizer of the medial side of the ankle joint 

• Lateral ligaments have 3 primary ligaments:

1. ANterior talofibular 

2. Posterior Talofibular 

3. Calcaneofibular 

Lower leg compartments 

~Compartment syndrome 

• Pressure in the compartments of the leg which causes cell death from either no blood in or from no blood coming out 

• High systolic blood pressure (first number) no blood in 

• High diastolic bp (Second number) no blood out 

Ankle injuries 

~ Ankle sprains can occur in virtually any sport 

• Inversion sprains are more common, 80-85% of all ankle sprains are to the lateral ligaments 

• Eversion sprains, while less frequent, are to the medial ligaments and are often very severe 

Syndesmotic Ankle Sprain 

~The syndesmotic ligament (in between the tib fib) 

• High ankle sprains affect the posterior and anterior tib-fib ligament 

~Tibiofibular sprains or high ankle sprains 

• Tib-fib sprains involve dorsiflexion followed by external rotation of the foot 

• Athlete is unable to dorsiflex foot, walks on toes 

Chronic ankle instability 

~Chronic ankle instability is when an athlete experiences repeated ankle sprains 

~Functional causes 

• Rehabilitate weakened structures 

• Restore ankle proprioception and neuromuscular control 

~Prevention 

• Taping or bracing 

• Bracing is better than taping 

• Bracing with high toe shoes is best 

ANkle Fracture/dislocations 

in some cases the ankle can be fractured or dislocated 

~Cause of injury 

• Often similar to those seen in ankle sprains 

~Signs of injury 

• Swelling and pain may be extreme with possible deformity 

Tibial and Fibular fractures

~Cause 

• Impact injuries 

~Need to make sure there is vascularity through the leg  

Stress fractures of the Tib-Fib 

~Cause of injury 

• Common overuse of the leg 

• Result of repetitive loading during training and conditioning 

~Signs of Injury 

• Point tenderness, difficult to discern bone and soft tissue pain 

• Pain 

• Pain within activity 

Tendon injuries 

• Athletes who dramatically increase workout times or running distances, or who run on hard, uneven, or uphill surfaces are prone to achilles tendonitis 

• The injury can be either acute or chronic. Acute injuries often associated with explosive jumping 

Tendonitis 

~ Signs and Symptoms 

• Increased temp in the immediate area 

• Tendon is painful on touch and movement and appears thickened 

Achilles tendon rupture 

~ SIgns and Symptoms 

• Swelling and deformity at site of injury 

• Athlete reports a pop or snap associated with the injury 

• Pain in lower leg that ranges from mild to extreme 

• Loss of function, mainly in plantar flexion 

Medial Tibial Stress syndrome (Shin SPlints) 

~ Shin Splints is a very common disorder of lower leg 

• The membrane covering the bone (periosteum) becomes inflamed 

• Pulling away from the bone (periostitis)

~The pathology of this disorder are unclear 

• May relate to biomechanics and neuromuscular characteristics or to training errors 

Shin Contusion 

~Cause of injury 

• Direct blow to lower leg (impact periosteum)

~Signs of injury 

• Intense pain and rapid forming hematoma 

Compartment syndrome 

~Compartment syndrome involves a swelling of the muscles inside lower leg compartments 

• Swelling puts pressure on vessels and nerves, can cause permanent damage 

FOur components: 

1. Anterior (most common)

2. Lateral 

3. Superficial posterior 

4. Deep posterior 

~Acute trauma, such as being kicked in the leg, can result in swelling within the compartment